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HomeWhat is Prescription Drug Abuse?
Although most people take prescription medications responsibly, there has been an increase in the non-medical use or, as National Institute on Drug Abuse (NIDA) refers to, abuse of prescription drugs in the United States.
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What are the Concerns?
A number of published reports indicate that prescription drug abuse is on the rise in the United States. According to the 2003 National Survey on Drug Use and Health, 6.3 million Americans aged 12 and older have used prescription medications for non-medical purposes in the prior 30 days.
AN ESTIMATED: |
| * 4.7 million used pain relievers |
| * 1.8 million used tranquilizers |
| * 1.2 million used stimulants |
| * 0.3 million used sedatives |
The number of new non-medical users of pain relievers increased drastically-from 573,000 in 1990 to 2.5 million in 2000. Overall, men and women have roughly similar rates of non-medical use of prescription drugs (an exception is found among 12-17-year-olds, with more females likely to abuse these drugs).
The Drug Abuse Warning Network (DAWN), which monitors drug mentions (medications and drugs of abuse) from emergency departments (EDs) across the Nation, recently reported that two of the most frequently mentioned prescription medications in drug abuse-related cases are benzodiazepines (e.g., Valium, Xanax, Klonopin, and Ativan) and opioid pain relievers (e.g., oxycodone, hydrocodone, morphine, methadone, and combinations that include these drugs). In 2002, benzodiazepines accounted for 100,784 ED visits categorized as drug abuse-related cases and opioid pain relievers accounted for more than 119,000. Between 1994 and 2002, ED reports of hydrocodone
and oxycodone overdoses increased by 170% and 450%, respectively. While ED visits attributed to drug addiction have been increasing, suicide-related visits have remained stable since 1995.
What Types of Prescription Medication are Commonly Abused?
Several classes of medications that are commonly abused include opioids, central nervous system (CNS) depressants, and stimulants. Certain over-the-counter (OTC) medicines can also be abused when not taken as directed. It is important to note that many prescription drugs or OTC medications can produce dangerous health effects when taken concurrently or taken with alcohol.
* Opioids. Opioids are commonly prescribed to treat pain. Examples of prescription opioids include morphine (Kadian, Avinza), codeine, oxycodone (e.g., OxyContin, Percodan, Percocet), hydrocodone (Lortab, Lorcet, Vicodin), propoxyphene (Darvon), fentanyl (Duragesic), and hydromorphone (Dilaudid). Opioids work in the brain to diminish the perception of pain. Opioids also can produce a sense of euphoria by affecting pleasure centers in the brain. This is often intensified when opioids are taken by routes other than those prescribed. For example, OxyContin can be crushed and snorted, or injected intravenously-this can enhance the euphoric effects, while at the same time increasing the risk for serious medical consequences, such as overdose.
* CNS Depressants. CNS depressants commonly are prescribed to treat anxiety and sleep disorders because of their ability to slow normal brain function. These medications include barbiturates, such as mephobarbital (Mebaral), pentobarbital sodium (Nembutal), butalbital (Fioricet), and benzodiazepines such as diazepam (Valium), chlordiazepoxide HCl (Librium), alprazolam (Xanax), triazolam (Halcion), and others.
* Stimulants. Stimulants, including dextroamphetamine (Dexedrine and Adderall) and methylphenidate (Ritalin and Concerta), are used primarily to treat attention deficit hyperactivity disorder, attention deficit disorder, and narcolepsy. These stimulants increase the amount of certain chemicals in the brain and peripheral nervous system. This can lead to increased blood pressure and heart rate, and increased blood glucose.
Who is Most Vulnerable?
- Adolescents. According to the 2003 National Survey on Drug Use and Health, 9.2% of youth aged 12 -17 had used a prescription psychotherapeutic drug for nonmedical reasons in the past year and 4.0% were current users. Prescription opioids are a particularly serious problem in this age group. NIDA's 2004 Monitoring the Future survey of 8th, 10th, and 12thgraders found that 5.0% of 12th-graders reported abusing OxyContin in the past year, and 9.3% reported abusing Vicodin, making Vicodin one of the most commonly abused prescription drugs in this population. Another troubling trend is the recent phenomena known as "pharming," where young people mix prescription medications and ingest some or all of them at once, unaware of potentially severe drug interactions.
- Elderly Adults. Although persons 65 years of age and above comprise only 13% of the population, they are prescribed approximately one-third of all medications in the United States. In addition, older patients are likely to be prescribed more long-term prescriptions, as well as multiple prescriptions, which could potentially result in unintentional misuse. A large percentage of older adults also use OTC medicines and dietary supplements, along with prescription medications, which could lead to dangerous results. The elderly also are at risk for prescription drug abuse, in which they intentionally take medications that are not medically necessary. Because of high rates of comorbid illnesses among the elderly, changes in drug metabolism with age, and the potential for drug interactions, prescription and OTC drug abuse or misuse can have more adverse health consequences among this age group.
- Gender Differences. Studies suggest that women are more likely than men to be prescribed an abusable prescription drug, particularly narcotics and antianxiety drugsÑin some cases, 55% more likely. Overall, men and women have roughly similar rates of nonmedical use of prescription drugs. An exception is found among 12- to 17-year-olds. In this age group, young women are more likely than young men to use psychotherapeutic drugs nonmedically. In addition, research has shown that women are at increased risk for nonmedical use of narcotic analgesics and tranquilizers (e.g., benzodiazepines). However, among women and men who use a sedative, anti-anxiety drug, or hypnotic, women are almost two times more likely to become addicted.
Trends in Prescription Medication Abuse
2005 Monitoring the Future (MTF) Survey*
MTF assesses the extent and perceptions of drug use among 8th, 10th, and 12th grade students nationwide. In 2003, the survey showed that lifetime, annual, and 30-day** use of tranquilizers had declined significantly from 2002 for 10th- and 12th-graders. This was the first year of decline for 12th-graders after a decade of gradual increase. In general, 8th-graders’ rates of reported tranquilizer use have been considerably lower than those observed in the upper grades. These figures remained statistically unchanged in 2005, with 6.8% of 12th-graders, 4.8% of 10th-graders, and 2.8% of 8th-graders reporting annual use of tranquilizers.
Only 12th grade data are reported for use of sedatives. Lifetime use of sedatives among high school seniors remained statistically unchanged between 2004 (9.9%) and 2005 (10.5%).
Only 12th grade data are reported for abuse of narcotics other than heroin in the MTF. The annual prevalence of this class of drugs had risen considerably, from 3.3% in 1992 to 7% in 2000 and 6.7% in 2001. In 2002, the survey item was changed to incorporate three new specific pain relievers, OxyContin (a controlled-release form of oxycodone that can cause severe health consequences if crushed and ingested), Vicodin (hydrocodone), and Percocet. Following this change, past year use was reported by 9.4% of seniors in 2002, 9.3% in 2003, 9.5% in 2004, and 9.0% in 2005.
Beginning in 2002, new items asking specifically about the use of OxyContin and Vicodin were also added to the survey. Annual use of OxyContin by 12th-graders has risen from 4.0% in 2002 to 5.5% in 2005. Annual OxyContin use has remained more stable in the lower grades since 2002, with 1.8% of 8th-graders and 3.2% of 10th-graders reporting annual use in 2005. The annual prevalence rate for Vicodin was considerably higher than for OxyContin, at 9.5% among 12th-graders, 5.9% among 10th-graders, and 2.6% among 8th-graders in 2005. Considering the addictive potential of oxycodone and hydrocodone, these are disturbingly high rates of use.
2004 National Survey on Drug Use and Health (NSDUH)***
According to the 2004 NSDUH, an estimated 6.0 million persons, or 2.5% of the population age 12 or older had used prescription psychotherapeutic medications nonmedically in the month prior to being surveyed. This includes 4.4 million using pain relievers, 1.6 million using tranquilizers, 1.2 million using stimulants, and 0.3 million using sedatives.
The estimated number of people aged 12 or older abusing OxyContin in their lifetime increased from 1.9 million in 2002 to 3.1 million in 2004. Increased rates of lifetime OxyContin abuse were seen in each age group, with the largest increase (from 2.6% to 4.3%) occurring among young adults aged 18 to 25. Also among young adults, lifetime abuse of tranquilizers increased from 11.2% in 2002 to 12.2% in 2004, and the proportions abusing any pain reliever and any prescription drug in their lifetime and during the past month also increased over that period. Among youth aged 12 to 17, past year abuse of prescription stimulants declined from 2.6% to 2.0%.
2004 Drug Abuse Warning Network (DAWN)****
The Drug Abuse Warning Network (DAWN), which monitors medications and illicit drugs reported in emergency departments (EDs) across the Nation, found that two of the most frequently reported prescription medications in drug abuse-related cases are benzodiazepines (e.g., diazepam, alprazolam, clonazepam, and lorazepam) and opioid pain relievers (e.g., oxycodone, hydrocodone, morphine, methadone, and combinations that include these drugs).
For 2004, DAWN estimates 495,732 ED visits involved in the nonmedical use (i.e., misuse or abuse) of prescription drugs or OTC pharmaceuticals or dietary supplements. Multiple drugs were involved in more than half (57%) of these ED visits.
In 2004, benzodiazepines accounted for 144,385 mentions that were classified as drug abuse cases, and opioid pain relievers accounted for more than 132,207 ED mentions. Methylphenidate, a central nervous system stimulant that has recently captured much public attention, occurred much less frequently. DAWN estimates 1,541 ED visits associated with methylphenidate abuse.
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